Health PsychologyChapter 12

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The Psychological Aspects of an Athletes
Perception of Injury Presented by Jake Resch
JRSAT
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• Psychological and Physiological Factors
  Contributing to Injury
• Accepted Models
• Rotella (1982) McDonald and Hardy (1990)
• Lerch (1984) Heil and Russel (1987)
• Eldridge (1983) Passer (1982)
• Lynch (1988)
• Martens (1977)
• Nideffer (1980)
• Weiss and Troxel (1986)
• Weiss and Weiss (1987)

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• Psychological and Physiological Factors
  Contributing to Injury
• Psychological Factors
• Daily Hassles
• Personality Traits (Extravert vs. Introvert,
  Hardiness, locus of control, self-efficacy,
  perfectionist, etc)
• History of Stressors
• Previous injuries
• Stressful life events
• Coping Resources (Strategies available to aid in
  coping)
• Social Support Which lead to

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• Psychological and Physiological Factors
  Contributing to Injury
• Physiological Factors
• Tensing of Muscles
• Double Pull
• Narrowing of Field of Vision
• Inability to concentrate
• Insomnia
• Nausea

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• Elisabeth Kubler-Ross
• Joint Citizenship in U.S. and Switzerland
• Graduated from the University of Colorado in 1963
  with a degree in psychiatry
• Released On Death and Dying in 1969
• Has published 9 books relating to death
• Holds 25 honorary doctorates

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• 5 Stages of Death
• Denial Unrecognized distress. Denial includes
  avoidance, minimizing, feelings of shock and
  disbelief, and outright failure to accept the
  severity of the injury.
• Anger Why me?
• Bargaining An attempt to postpone it has to
  include a prize offered for good behavior, it
  also has a self-imposed deadline, and it includes
  an implicit promise that the patient will not ask
  for more if this one postponement is granted.

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• 5 Stages of Death continued
• Depression Five of the following within 2 weeks
• Depressed mood
• Diminished interest and pleasure in most
  activities most of the time.
• Significant weight loss or weight gain or
  decrease in appetite
• Sleep disturbances
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Diminished ability to concentrate
• Recurrent thoughts of death or suicidal ideation

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5 Stages of Death continued Acceptance
Reaching a stage during which he or she in
neither depressed nor angry about his or her,
fate.
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• The Athletic Identity
• Definition Identity based upon physical skills
  and involvement in sport.
• Impact of Injury on Athletic Identity
• May take away career
• Threaten invincibility and immortality
• Loss of companionship with teammates, coaches,
  etc..
• Loss of self-esteem and self-confidence
• If severe enough athlete may require counseling
• If I am not an athlete then, who am I?

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So where does Kubler-Ross fit in?
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• On Death and Dying of the Athletic Identity
• The injured athlete vs. the terminally ill
  patient
• Injured Athlete Terminally ill Patient
• -Denies injury and attempts to play -Denies
  impending death
• -Athlete knows the injury is there -No illness is
  present
• -Resentment of healthy teammates -Resentment of
  the healthy
• -Bargaining includes good behavior, -Bargaining
  with a higher
• by adhering to rehabilitation protocols power
• - Impending depression - Impending depression

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• Should Kubler-Rosss Theory be used with
  Athletics?
• Pros Cons
• -It has been used as the standard -Not tested
  in the population to which the
  stages are being applied
• Athletes seem to follow similar patterns - Hard
  to assess different stages
• - Assumes athletes proceed
  linearly and sequentially through
  mood stages
• - Assumes athletes reach
  resolution or acceptance
  regarding injuries
• - Stages are discrete

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Ok, now what?
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• Recognizing Stages
• Athletic Training should be capable of delivering
  motivational, stress reducing, and imagery
  techniques to rehabilitating athletes,
  recognition of psychological disturbances, and
  referral processes
• TOP 5 REASONS WHY ATHLETIC TRAINERS SHOULD CARE
• Generally spend longer periods of time with
  injured athletes than other members of the health
  care team
• Athletes are more likely to raise psychological
  concerns during the rehabilitation period.
• Touch is a very, very powerful thing .
• Psychological aftereffects of injury should be
  discussed concurrently with physical
  rehabilitation
• We are in an ideal situation to provide primary
  psychological services
• Role Delineation Study (Domain III Subsection D)

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• Skill and Qualities Needed to be Effective
• Being there (FISH VIDEO)
• Recognizing psychosocial emergencies
• Stronger relationship with athlete opposed to
  others of the health care team
• Athletic Trainer works closely with athlete, in
  turn the athlete may confide in the athletic
  trainer
• Observing the athlete during rehab, with his or
  her team mates, or comments from teammates may
  indicate psychological issues
• Athletic Trainers should recognize what their
  limitations are, and they should be aware of the
  boundaries of practice when providing
  psychological help to athletes during
  rehabilitation.

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Kubler Ross
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Bob Rotella Former Director of the University of
Virginia Sports Psychology Department
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Determined coping Acceptance of injury and its
impact on the athletes short-term and long-term
goals
The Affective Cycle of Injury
Determined Coping
Distress
Denial
Distress Disrupting and disorganizing impact of
an injury on emotional equilibrium
Denial A sense of disbelief as well as varying
degrees of outright failure to accept the
severity of injury
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• Differences
• Focuses on a repetitive cycle instead of linear
  transition
• Incorporates three important theories from
  Kubler-Ross
• The transformation of emotional stages
• The importance of denial
• The patients active work of recovery

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The Individual Zones of Optional Functioning
(IZOF) And the Affective Cycle
High Positive Effect
Determined Coping
Flow
High Negative Effect
Low Negative Effect
Distress
Denial
Low Positive Effect
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Coachs Injury Checklist Look
Situational __ Poor compliance with
rehabilitation (exercise, medication, activity
restrictions) __ Rehabilitation Setbacks __
Reinjury following return to play __ Mental
errors following return to play __ Failure to
perform up to physical ability
Personal __ Loss (shows sadness or apathy
withdraws from team or coach) __ Threat (often is
nervous or uptight shows outright fear at times
balks or hesitant in key situations) __
Overconfidence (acts unconcerned about injury
exaggerates past or future accomplishments) __
Pain (complains or shows signs of physical
discomfort) Listen __Life
Problems? (sport, school, home,
friends) __Physical Problems? (headache, sleep,
or stomach problems, or other worries about
health) __ Goals for performance? (unable to
identify realistic goals) __ Worry about Injury?
(uncertain regarding full recovery, concerned
about making up for lost time worried about
teammates or coachs reaction to injury
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CONCLUDING THOUGHTS!!
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• A little thing called the Role Delineation..
• Facilitate referral or guidance for
  psychological crisis by implementing established
  intervention strategies to match services to the
  need.
• Knowledge of
• Psychology, guidance, theory and application
• Common psychosocial conditions
• 3. Appropriate intervention techniques
• 4. Conflict resolution strategies
• 5. Resources for professional referral
• 6. Indications or contraindications for
  participation

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• An Athletic Trainer needs Skills in.
• 1. Applying appropriate intervention techniques
  
• 2. Applying auditory, verbal and nonverbal
  communication skills
• 3. Applying conflict resolution strategies
• 4. Referring to appropriate medical personnel

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The End